EBC - ON DEMAND
European Bifurcation Club 2018 – EBC 2018 – Brussels, Belgium
LM PCI techniques and results
Pathological mechanisms of left main stent failure
Author: Renu Virmani, MD CVPATH Institute, Inc. Gaithersburg, MD, USA
CONCLUSION: LM & BIFURCATION
- Ostial portion of LMCA is rich in elastic fibers and SMCs which can lead to elastic recoil, whereas distal bifurcation is characterized by flow disturbance and procedural complexity
- LM angle correlates with greater length of LM artery
- Atherosclerotic plaque at bifurcation was predominantly seen in lateral wall (low shear) rather than flow divider (high shear)
- Longer LM length is associated with greater luminal narrowing.
- In bifurcation stenting, lateral wall is likely to have thicker neointima, whereas uncovered struts are significantly greater in flow divider regions than in lateral wall.
- Causes of stent thrombosis in LMT are malapposition, protrusion of strut into aorta, medial tear, and strut crossing an ostial side branch
- No differences in stent thrombosis were observed between provisional vs. two stent technique
- Malapposition is mostly associated with stent failure in LMT stenting.
- We have traded thrombosis for restenosis by using DES